TIP – Training of Intensive medical support in the case of a Pandemic

The COVID-19 pandemic has led to a short-term sharp increase in the demand for auxiliary staff in emergency rooms and intensive care units. Against this background student tutors of the Medical Faculty Erlangen have developed a training concept. The aim was to familiarize students in the clinical section quickly and effectively with skills that are particularly important in a clinical assignment as (student) assistant in the care of corona patients (e.g.: personal protective equipment, intubation assistance, arterial blood collection, assessment of blood gas values and ventilation parameters). In a blended learning concept, learning materials were prepared in advance and then implemented and deepened in a presence phase. The selection of learning materials and the low supervision ratio (1:2) made it possible to realize an internally differentiated approach. The offer met with great interest among students of all clinical semesters and was evaluated very positively. The skills learned can be applied widely even independently of a pandemic.


Introduction
COVID-19 has presented new challenges, especially for medical staff, that were previously little known. Medical knowledge is changing at a speed not previously perceived. Treatment concepts that are still up-to-date are being discarded and replaced in updated form [1]. The aim of the project is to quickly provide medical students of different semesters with pandemic-related basic skills for the care of corona patients for use as assistants. A model for TIP was the deployment of medical students during the polio epidemic in Copenhagen in 1952/53 [2], [3]. TIP recruits medical students from all semesters, so that the level of education of the participants is very inhomogeneous. In addition, practical skills are imparted very inhomogeneously during the various stages of the study program (nursing internship, clinical traineeships, internships, PJ).

Project description
Against this background, the student tutors of the Skills Lab PERLE (Praxis ERfahren und LErnen) and the Simulation and Training Center Anaesthesia (STZ) developed a basic training concept for students. The goal is to be able to use it in the short term to support patient care in the context of a pandemic. The focus of this training concept is on skills that are needed in the current situ-ation in the emergency room and intensive care unit. The skills imparted are of course also helpful outside of a pandemic, for example in identifying critically ill patients. The student tutors, in cooperation with intensive care personnel, identified 8 skills that can be important for support and are important for the self-protection of staff. These skills are taught in the medical curriculum mainly theoretically and not systematically. TIP (Training of Intensive Medical Support in the Case of a Pandemic) is based on a blended learning concept in which the course participants work through learning materials in advance in order to apply and deepen these contents in the practical attendance phase. For the practical training, the participants receive a decision and memory aid (smock pocket card) to focus on learning and practicing practical skills and to support the development of procedural knowledge. A further aspect in the development of the course concept lies in a time-optimized, qualitatively excellent attendance phase.

Methods
In the preliminary learning module, students deal with various topics: • Current COVID-19 information: Focus on infection path, incubation period, symptoms, diagnostics, complications, therapy For a more in-depth study of the topics, further specialist literature is suggested and the reader is encouraged to conduct his own research. These measures are intended to achieve a more homogeneous level of knowledge at the beginning of the practical training of students from different semesters in the sense of an internally differentiated approach [4]. The practical training takes place at 6 stations and lasts four hours. Two participants are trained at each station in rotation by an instructor/tutor. The observance of the distance rules can therefore be implemented without any problems. The basic hygienic aspects (social distance, mouth and nose protection, hand disinfection) are pointed out during the introduction to the training course (station 0). Throughout the entire training, the tutors also pay attention to the correct implementation of these aspects.
The following skills are taught at the other stations: • Protective clothing, donning and doffing (= "donning/doffing" -with and without buddy) • Intubation assistance (preparation) • Nasopharyngeal sample collection for COVID-19 testing • Arterial blood collection from arterial catheter • Arterial puncture on the puncture trainer • Handling of perfusers and preparation of catecholamines (dilution) • Basics of ventilation and blood gas analysis (alarm station; recognition of critical situations) At the wards (see figure 1), previous knowledge is first of all assessed by the tutors who have been comprehensively trained by the intensive care personnel. The skills are then imparted in a differentiated manner within the hospital; students with less previous knowledge receive a basic training, students with more previous knowledge receive more detailed information on the skills. All have the opportunity to deepen their practical skills through

Implementation
On 12 course days 72 students were trained with "TIP" (see figure 2). All participants reflected their impressions in a freely formulated feedback (see table 1). The tutors also presented their experiences and impressions in a feedback. The feedback was used to optimize the course process and the course content. In summary, the choice of stations and content was very positively received. Both the preparation for the course and the implementation at the respective stations was experienced as goal-oriented. The hygiene aspects and the associated self-protection were perceived as important contents, also with regard to further infection situations or for the care of patients hygienically isolated for other reasons. A review of how the trained skills were applied to support intensive care personnel in their practical work has not yet been possible. Due to the tense overall situation, the primary concern was to evaluate the feasibility of the concept.